Munsen, Grace NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District
(Town Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CER-
TIFICATE OF DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK.
.l a .ill Registered No. ..�-
Dist. No; ..5601.... County WAVZfdnl or City Glens Falls Hospital
(If city, give street address)
Name of deceased Grace Helen Munsen Veteran No
(If veteran, give name of War)
Single, married, widowed, Widow January23 66
Sex Female or divorced (write the word) Date of Death 19
Age 70 Years 8 Months 5 Days Birthplace Twn Kingsbury Wash.Co.NY
Cause of-Death.Coronart.-yhrcuabosis.
Certificate was signed by....C„V.,Latimer M.D.
Address 100 John Street Hudson Falls N.Y.
Place of Burial (or Removal) Twn...Q.i4gen tki,4Xy Warren Co. "l.Y.
(If body is to be temporarily held, 1111 in space later)
Cemetery Pi.n,eview Date of Burial January 26 1966
(If body is to be temporarily held, fill in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation,.the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Number, and on the basis thereof I HEREBY GRANT A PERMIT
to Carleton Funeral Home Inc.LE.W.Wilson) Hudson Falls N.Y.
(Name) (Address)
theFLu er.41 Uir ctStr to hold tempor ily and Inter the body
(Undertaker or person having charge of corpse) Inter, vy oa�r otherwise dispose of [state how])
DatecJa.Ctlta�CY 25 19 66 (Signed) K./ ,e�
Lo Registrar
This Permit is sufficient for the Removal (and Interment or Cremation) of a body to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a Transit Permit (VS No, 62) is required.
Form VS. 61. (Rev, 6/63) (3A2-323)
ENDORSEMENT OF SEXTON OR PERSON IN CHARGE
OF PREMISES ON WHICH INTERMENTS qR
CREMATIONS ARE MADE
j
Date of(""--1 �`.2 was 1c -2" A" 19
(Intermentor. wiFsiH�
(Name of Cemetery, Crematorium, etc.) /
r
1
Section 2'Z-^ Lot No/2_'T2 1 Grave No,__.
(Signed) _ C.Gr--j6- . a__. i'
. I--V .0 z --7(-
(Person in Charge)
Address 7G' ' ,~-� -.--�
Person in charge must return this Permit to the Registrar
of his District within SEVEN (7) DAYS from above date. If no
person is in charge, the FUNERAL DIRECTOR or UNDER-
TAKER MUST SIGN ABOVE STATEMENT, write across the
face of the Permit the words "No person in charge," and FILE
PERMIT WITHIN THREE (3) DAYS with the Registrar of Dis-
trict in which cemetery is located.
SEXTONS,FUNERAL DIRECTORS and UNDERTAKERS
violating the law relative to the return of permits are liable to
a penalty of NOT LESS THAN FIVE DOLLARS NOR MORE
THAN FIFTY DOLLARS FOR THE FIRST OFFENSE.The law
will be enforced. Local Registrars are required, under penalty,
to report violations thereof.